Complex Cause of Ischaemic Stroke in Patient after Mitral Bioprosthesis Implantation - A Case Report


  • Andrzej Hrynkiewicz Department of Neurology, St.Vincent Hospital, Gdynia, Poland
  • Katarzyna Kosmalska
  • Krzysztof Jarmoszewicz Department of Cardiac Surgery, Pomeranian Hospital, Wejherowo, Poland
  • Marcin Fija?kowski First Cardiology Clinic of Medical University, Gda?sk, Poland


Prosthetic thrombosis, Embolic stroke, Left atrial appendage closure, Thrombus.


We present the history of 60-years-old woman with mitral and aortic bioprosthesis that have been implanted together with left atrial appendage closure. The patient had been treated with VKA and low dose of acetylsalicylic acid since the surgery. On 28th day of postoperative period an ischemic stroke occurred. In transoesophagal echocardiography we have discovered non-obstructive thrombosis of the artificial mitral annulus and a leakiness in left atrial appendage (LAA) closure. There was rapid outflow through the gap in closure directing to mitral annulus in close proximity to visible thrombus. The pathologic flow might have had the contribution in thrombus mobilization and stroke occurrence. We have decided to change anticoagulation to low molecular weight heparin. In control echocardiography, during heparin therapy, thirteen days later, there was remarkable worsening of annulus thrombosis with multiple thrombi present. Re-exchange anticoagulation to warfarin yielded in almost complete resolution of thrombosis after eleven days. We decided to continue anticoagulation over recommended three months not only due to incident of thrombosis but also suspicion of history of atrial fibrillation and presence of disrupted LAA closure.